Laboratory Studies

The most important laboratory study for endophthalmitis is Gram stain and culture of the aqueous and vitreous obtained by the ophthalmologist.

Real-time polymerase chain reaction (RT-PCR) has improved diagnostic results over traditional culture.^[22]

For endogenous endophthalmitis, other laboratory studies that may be performed include the following:

Complete blood count with differential - Evaluating for signs of infection, elevated white count, left shift
Erythrocyte sedimentation rate - Evaluating for rheumatic causes, chronic infections, or malignancy. The ESR is often normal in cases of endophthalmitis.
Blood urea nitrogen - Evaluating for renal failure or patients at increased risk
Creatinine - Evaluating for renal failure or patients at increased risk

Imaging Studies

Imaging studies include the following:

Chest radiograph - Evaluating for source of infection
Cardiac ultrasound - Evaluating for endocarditis as source of infection
CT scan/MRI of orbit - May help rule out other entities in the differential diagnosis
Ocular ultrasound – Helpful when positive findings are seen, such as low-amplitude mobile echoes, vitreous membranes, and thickening of the retina and choroid; however, sensitivity is not high enough to rule out the diagnosis with a negative ultrasound^{[3, 23]}

Other Tests

Other tests include the following:

Blood cultures - Evaluating for source of infection
Urine culture - Evaluating for source of infection
Other cultures depending on clinical signs or symptoms
- Cerebrospinal fluid - Evaluating for source of infection
- Throat culture - Evaluating for source of infection
- Stool - Evaluating for source of infection
- Indwelling intravascular catheter tip - Evaluating for source of infection
- A culture of the penetrating object, if available, can be a valuable resource.
- Vitreous culture obtained by the ophthalmologist

Procedures

Ophthalmological evaluation includes the following:

Check visual acuity
Examine both eyes by slit lamp biomicroscopy
Intraocular pressure
Dilated funduscopy
Possible ultrasonography if fundus not well visualized (This will help determine if a retained intraocular foreign body is present, the density of the vitreitis, and if the retina is attached or not.)
Routine cultures should include aerobic, anaerobic, and fungal cultures.

Treatment & Management

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Media Gallery

Severe endophthalmitis. Courtesy of Ron Afshari Adelman MD, MPH, MBA, FACS, Yale Medical Group.

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Author

Daniel J Egan, MD Associate Attending Physician, Associate Residency Director, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center; Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons

Daniel J Egan, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Radin Peters, MD Attending Physician, Urgent Care Center, Newton-Wellesley Hospital

Jessica Radin Peters, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David A Peak, MD Associate Residency Director of Harvard Affiliated Emergency Medicine Residency; Attending Physician, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American Medical Association

Disclosure: Partner received salary from Pfizer for employment.

James Semple, MD Resident Physician, Department of Emergency Medicine, Mount Sinai St Luke's-West

James Semple, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Liudvikas Jagminas, MD, FACEP Chief of Service, Attending Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Vice-Chair for Network Development, Department of Emergency Medicine, Beth Israel Deaconess and Harvard Medical Faculty Physicians; Adjunct Associate Professor of Emergency Medicine, The Warren Alpert Medical School of Brown University

Liudvikas Jagminas, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Trauma Anesthesia and Critical Care Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Richard Lavely, MD, JD, MS, MPH Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.